Are you one of the millions concerned about cholesterol levels and your lipids (fats)? Are you confused about which test to get? I've seen the rise and fall of many tests and panels, and sometimes they are confusing to me. Well, a new report in the Journal of the American Medical Association may put some concerns about testing to rest.
A study following more than 300,000 people has found that heart disease risk can be reasonably well assessed with nothing more than a standard total cholesterol/HDL cholesterol panel or apolipoproteins. And, to make things even simpler, you don't even need to fast.
I started measuring apolipoprotein B as part of my screens for risk. But now it seems that is unnecessary. And we've always told people to fast. These authors say that is immaterial. They also say that you don't even need the "bad" LDL cholesterol measurement in addition to total and HDL cholesterol. Finally, they also report that triglycerides levels are not independently associated with heart disease risk over total and HDL cholesterol measurements.
The report finds that total cholesterol and HDL cholesterol were "strongly" associated with heart disease risk, in opposite directions. That is, more HDL would mean less risk; more total cholesterol would mean more risk.
If this report holds up, it greatly simplifies (and makes far less costly) the measure of your risk of vascular disease. You don't need an enlarged lipid panel costing many hundreds of dollars. A simple total and HDL does it, and these are far easier to get than other lipid panels.
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On the other hand, I am concerned about discarding triglycerides. If you don't plan to fast, don't bother measuring triglycerides, since recent food will raise triglycerides. I like to do triglycerides for another reason. It is an indirect measure of insulin. If you are eating a bad diet, you will have higher levels of insulin. Insulin clears sugar by converting it to fats. In my many years and hundreds of patients' experience, I find definite clinical correlation to metabolic syndrome, insulin resistance, and later complications of these in those with high triglycerides. Hence, I will still measure triglycerides and do it fasting.
But this report does greatly simplify lipid assessment. It's not necessary for most people to measure all the lipid subfractions for reasonable risk assessment. Stick with total and HDL cholesterol. Strive to raise HDL (See my website for ways to do that), and lower total cholesterol (without drugs). If HDL is high, it means you're handling the cholesterol well.
I don't consider total cholesterol to be a bad guy in most people. The bad guy is oxidized LDL. But total cholesterol is just a marker that there might be other problems causing your liver to make more. In my experience, cleaning up your diet, exercise, detoxifying, sunlight, together with targeted nutritional supplements (like
Advanced Cholesterol Formula) will do more than any drug or drug combination could ever do.